Dementia Flashcards
What are the common causes of dementia?
Alzheimer’s disease
Vascular disease
Frontotemporal ementia
Dementia with Lewy bodies
Why is it difficult to accurately diagnose dementia in the clinic?
- The disease follows a heterogenous course (has several root causes)
- In old age the disease presentation is of
multiple co-morbidities (different diseases) - Lots of mixed and uncertain pictures (even though we can characterise a disease they also have other pathologies (effects) in the brain
- Younger patients are more typical
- Clinical history, the function of the patient
and how they change is paramount (difficult to acquire if patient is experiencing symptoms)
What is the Overview of the clinical process to diagnosing dementia?
- referral
- History
- Examination
- Investigations
- Diagnosis
- Management
What sort of things are discussed during the history taking for suspected dementia?
- Memory
- Language
- Numerical Skills (e.g. managing their finances)
- Executive skills
- Visuospatial skills (e.g. road traffic accidents)
- Neglect phenomena
- Visual perception
- Route finding and landmark
identification (“wondering”/ lost) - Personality and social conduct (disinhibition/ impulsivity)
- Sexual behaviour
- Eating (may eat more or less)
- Mood
- Motivation/Apathy
- Anxiety/Agitation
- Delusions/Hallucinations (often delusions of theft)
- Activities of daily living
Asking friends/ family can be vital; those with suspected dementia may not understand/ notice their symptoms
What is dementia?
severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of the underlying cause)
What does the Examination portion of the diagnoses consist of?
Testing the patient’s neurological mental state + focus tests:
- MMSE “Mini Mental State Examination”=
* score out of 30
- You may also conduct ACE III “Addenbrooke’s Cognitive Examination III”=
* score out of 100
* 15 minutes long-more memory focussed
- for Alzheimer’s there is also the MoCA assessment (Montreal cognitive assessment)
What investigations are used to monitor the dementia?
Neuropsychology
Bloods
MRI
PET
What blood tests are used in the investigation of dementia?
Full blood count
Inflammatory Markers
Thyroid Function
Biochemistry and renal function
Glucose
B12 and folate
Clotting
Syphilis serology
HIV
Caeruloplasmin
What changes are seen to an MRI scan, representative of dementia?
As the disease progresses:
-Narrowed gyri (folds of the cortx)
- Widened sulci (grooves)
- Ventricles are dilated/ enlarged
- medial temporal volume lost
- Hippocampus volume lost
(black areas on MRI= areas replaced by CSF)
What changes are seen in an amyloid PET scan that are representative of dementia?
- PET scans involve injection of “contrast” that travels to the brain and lights up the “amyloid” in our brains
- Patients with dementia have high amounts of amyloid
- =PET scan lights up a lot (mean cortical SUVr is very high)
What are the different types of dementia?
- Alzheimer’s (disease causing dementia)
- Vascuclar dementia
- Dementia with Lewy bodies
- Frontotemporal Dementia
How is dementia managed?
- “Wait and watch”- be more confident of diagnosis
- Acetylcholinesterase inhibitors (result in higher concentrations of acetylcholine, leading to increased communication between nerve cells, which in turn, may temporarily improve or stabilise the symptoms of dementia)
- Treating behavioural/psychological symptoms
- Occupational therapy/Social services
- Specialist therapies
How long does the clinical process of diagnoses take for dementia?
6 months- 2 years
How would you distinguish between Delirium vs dementia vs depression?
Dementias have some atypical variants:
Alzheimer’s=
(subtle, insidious amnestic/non amnestic presentations)
Vascular dementia=
(related to cerebrovascular diseases with a classical step-wise deterioration +- multiple infarcts)
Dementia with Lewy bodies=
(cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and
fluctuating cognition)
Frontotemporal dementia=
(behaviour variant FTD, semantic dementia, progressive non-fluent aphasia)
Rapidly progressing dementias
What is the function of the entorhinal cortex?
- The entorhinal cortex (EC) is a critical element of the hippocampal formation located within the medial temporal lobe
- The entorhinal cortex is the gateway for information entering and leaving the hippocampal formation.
- The entorhinal cortex is a component of the medial temporal lobe memory system, although it is increasingly believed to have a perceptual function
